Auto Insurance Claims/Auto Accident

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Expert: Claims Guy - 6/27/2015

QuestionHi,
My car was totaled by another driver a few weeks ago when she did not stop at the stop sign. I've reported the claim to my personal insurance company and they took are of giving me market value for the totaled vehicle. In addition, to the totaled car I am also experiencing mostly soft tissue injuries (sore back, neck, and shoulders). I've used the medical payments from my own insurance to pay for the ER visits. The at fault driver's insurance company contacted me and wanted to make a medical agreement offer which consisted of several medical visits as well as $500 general damages and the compensation for missing a few days of work. I went to a few follow up appointments and it takes a good couple hours each time from my work day. Can I ask to be compensated for the time that I've away from work due to the appointments. The chiropractor advised that it'll take several months before I'll start to feel better and I just can't afford to take more unpaid time off of work. Can I negotiate the medical agreement offer? Will the at fault driver's insurance company reimburse me or my insurance company for the medical payments that my insurance company paid to the medical providers?

AnswerYour injury settlement will include special damages (medical bills, lost wages, any other out of pocket expenses) and general damages (pain, suffering, aggravation, etc). The time away from work for doctor appointments should be included as long as it was reasonable and necessary. The general damages will depend on the severity of the injury and the time for recovery. Your question about whether the at fault insurer will repay your insurer for medical bills they pay will depend on the insurance law in your state. I do not work in California so I am not sure, but just ask your claim rep and he/she will explain it to you. In some states, you get to double collect for those bills; in some states you cannot.

$500 for generals sounds very low. This is an initial offer and it is definitely negotiable. They are probably trying to close your claim quickly, which is fine if the injury is not significant. If you expect to treat for a while, you should not settle now, until you know the severity of the injury. When you are healed, i can help you determine a fair value.

However, I would be very suspicious of a chiropractor who told you it will takes months to heal. That is nonsense, if this is really a soft tissue injury. For a soft tissue injury, the pain generally increases over the 1st 24-72 hours and then slowly negins to heal. If you have no medical treatment at all, it will heal the same as if you have chiro treatment or physical therapy. The treatment is generally designed to make you feel better while healing. Known as Palliative care. It does not help you heal. The only thing you can do to speed the healing is exercises that build your core muscles. What I am saying is well established in the medical community and by the AMA. A soft tissue injury is merely a strain or sprain of the muscle. This should heal in a few days or up to a few weeks if very severe.

There are many unscrupulous chiropractors, doctors, and physical therapists, and attortneys who work in "accident clinics" whose focus is extending your treatment and building their bills. There is a huge industry surrounding the accident industry. Be careful, because if the at fault insurer does not believe your treatment was reasonable and necessary, they may refuse to pay some of it, and you may need to hire an attorney to file a lawsuit, and you may not win.

Claims Guy

Expertise

I am currently an Auto Claims Manager for a large insurance company. I have 20 years experience in the industry, having worked as a Claims Adjuster, Injury Settlement Negotiator, Claims Manager, SIU/Fraud Investigator, and Compliance Officer......I can answer questions related to any aspect of Automobile insurance claims and coverages. I can provide an inside look at how insurers operate. I always treat my customers fairly and want to help make sure you are treated fairly. However, please keep in mind that being treated fairly according to the law does not guarantee that you will get what you want. I can also answer some questions regarding Homeowner's and other types of insurance claims. I have handled all types of auto insurance claims and coverages. I am NOT an automotive repair expert but can give advice re how insurers handle complex repair issues. Please keep in mind that every state has its own set of laws pertaining to rules of the road, liability, and insurance. No one is an expert on every state. I am most familiar with laws in Maryland, DC, West Virginia, and Virginia, but will attempt to answer questions for other states. I am not an attorney an cannot provide legal advice. My advice will be my opinion based on my experience.

Experience

I am currently an Auto Claims Manager for a large insurance company. I have 20 years experience in the industry, having worked as a Claims Adjuster, Injury Settlement Negotiator, Claims Manager, SIU/Fraud Investigator, and Compliance Officer. I am not an attorney an cannot provide legal advice. My advice will be my opinion based on my experience.